Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis

Abstract Aim To identify the effects of strength and balance training on dynamic balance and patient reported outcomes in people with chronic ankle instability(CAI). Method Five databases(CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched in September 2022. The search was conducted on randomized controlled trials(RCTs) that the effects of strength training, balance training and combination of strength and balance training in people with chronic ankle instability compared to a control group. Using Review Manager 5.3 and Stata-SE 15 to conduct Meta-analysis on the included literature. methodological quality and risk of bias were assessed by using the PEDro scale. Results A total of 33 Chinese and English RCTs document were screened and 1154 patients with CAI were included in the study. Compared with control group, strength training, balance training and combination of strength and balance training demonstrated to be more effective in terms of improving patient reported outcomes(strength training: SMD = 0.80, 95%CI = 0.39–1.22; balance training: SMD = 0.79, 95%CI = 0.41–1.17; combination of strength and balance training: SMD = 1.28, 95%CI = 0.57, 1.99). Subgroup analysis: Intervention for 6 weeks, more than 3 times a week and more than 30 min each time were the best rehabilitation programs to improve CAI patientreported outcomes. Compared with control group, balance training demonstrated to be more effective in terms of improving Star Excursion Balance Test (SEBT)((anterior: SMD = 0.71, 95%CI = 0.03–1.40; posterolateral: SMD = 0.84, 95%CI = 0.22–1.46; posteromedial: SMD = 0.88, 95%CI = 0.45–1.32). However, strength training and combination of strength and balance training had no improvement effects on SEBT. Conclusions Available evidence showed that, results of the comparison between balance training versus strength training suggest that the combination of strength and balance training achieves greater benefits for patient reported outcomes and balance training could bring greater benefits to dynamic balance. Strength training should be used cautiously in clinic to improve the dynamic balance in individuals with CAI. Trial registration ( http://www.crd.york.ac.uk/PROSPERO , Registration No. CRD42022371396).